882

The whole calculus is elongated in shape, the urethralportion being attached to the vesical by a distinct neck.It measures 3 inches in length; greatest girth 4 inches;greatest breadth 1 inches. The urethral portion measuresIt inches in length and 2 inches in girth. The vesicalportion is 2 inches long and 4 inches in girth. The wholestone weighs 760 grains; the vesical portion contributingto this 600 grains. The vesical part consists of a nucleusof uric acid, with a coating of phosphate of lime; theurethral portion, on the other hand, being composed ofoxalate of lime.

July 27th.-Patient has gone on favourably since theoperation. On the afternoon of the 25th she began to re-tain her water and was free from pain. She had to makewater only twice last night, and passed it without pain.The wound in the urethra is healing kindly.

Aug. 2nd.-Had a slight feverish attack two days ago,but is now progressing favourably. Pain has completelydisappeared. She is able to retain her urine almost per-fectly, only a little dribbling from her. Patient dischargeda few days after this.

CASHEL UNION HOSPITAL.FORCIBLE RUPTURE IN FIRM FIBROUS ANCHYLOSIS.

(Under the care of Dr. LAFFAN.)THE two following cases tend to illustrate the safety and

efficacy of forcible rupture.J. and C. L-, husband and wife, aged forty and forty-

five years respectively, labourers, were admitted some timesince into the above hospital. They were stout, strong,country people, albeit a good deal cut up by the illness underwhich they laboured. Their previous history was as fol-lows :-The female contracted some months before gonor-rhoea. This she communicated to her husband, who, a fewdays afterwards, got acute rheumatism, his right kneeand ankle joints being inflamed. The wife subsequentlywas attacked with rheumatism, which involved the cor-responding joints.On admission, it was found that faulty position had pro-

duced firm fibrous anchylosis of the affected knee-joint ineach case. In the female the leg was so bent as almost totouch the thigh. To complicate matters, she was in theeighth month of her pregnancy. The deformity was notso great in the man’s case. Some pain, swelling, and ten-derness were also present in both the affected joints. The

anchylosis being judged to have gone too far to leave muchto be hoped for from medical treatment, forcible rupturewas resolved on. The advanced pregnancy of the womansurrounded her case with special difficulties. It was, how-ever, after careful consideration, found better on the wholeto operate on her at once than to give the anchylosing pro-cess the scope which the necessary delay till after deliverywould afford it. Complete rest was meanwhile enjoined,and evaporating lotions used for a few days before ope-rating.The husband was first operated on, chloroform having

been previously administered. The connecting bands wereeasily broken through ; and the leg having been straight-ened, a long splint was applied. The wife was next ope-rated on, under the influence of chloroform; but the an-chylosing bands were found in her case so strong that itwas deemed more prudent to devote two operations to theircomplete rupture. Some increase in the local inflammatorysigns followed in both instances; but they were easily sub-dued by appropriate treatment. After a few weeks theman’s knee-joint was completely restored. The wife’s pro-gress was slower; but she, too, gained in time a perfectjoint.

PATHOLOGICAL SOCIETY OF DUBLIN.-The follow-ing officers have been elected for the ensuing year :-Pre-sident : George H. Kidd. Council: John Hamilton, Thos.Hayden, James S. Hughes, R. Law, Benjamin G. McDowel,Robert McDonnell, William Moore, George H. Porter, Jas.H. Wharton, Henry Head, Edward Bennett, and Arthur W.Foot. Honorary Secretary: William Stokes. Secretaryand Treasurer: Robert W. Smith. Secretary for ForeignCorrespondence : Robert D. Lyons.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, DECEMBER 10TH, 1872.T. B. CURLING, F.R.S., PRESIDENT, IN THE CHAIR.

PATHOLOGY OF CHRONIC BRIGHT’S DISEASE WITH CONTRACTEDKIDNEY, WITH ESPECIAL REFERENCE TO THE THEORY

OF "ARTERIO-CAPILLARY FIBROSIS."

BY GEORGE JOHNSON, M.D., F.R.S.,PHYSICIAN TO KING’S COLLEGE HOSPITAL.

THE author began by referring to his discovery of hyper-trophy of the muscular walls of the minute arteries in casesof chronic Bright’s disease, published in the 51st volumeof the Medico-Chirurgical Transactions. This result of aquarter of a century’s careful observation is now called inquestion by Sir William Gull and Dr. Sutton, who, in therecently issued volume of the Transactions, propound doc-trines of great novelty relating to the pathology of Bright’sdisease. They give a brief summary of their conclusions atpages 295-6. Dr. Johnson now proposed to inquire whetherthese conclusions are in accordance with pathological factsand with physiological principles.To prove that hypertrophy of the heart is a consequence

of 11 arterio-capillary fibrosis," and not of degeneration ofthe kidney, they refer to six cases in which it is said thatthe cardio-vascular changes were present, while the kidneyswere healthy or but little altered in structure. In each ofthese cases Dr. Johnson maintains that the hypertrophy ofthe heart was due, not to changes in the minute blood-vessels, but to other obvious causes. In one case (No. 7),aged forty-two, there was emphysema of the lung and bron-chitis ; in one (Case 10), aged sixty-nine, there was senilegangrene and, of course, degeneration of the larger arteries;in one (Case 20), there was disease of the aortic valves;one patient, who was sixty-three years of age (Case 2), pro-bably had senile degeneration of the arteries, and her kid-neys weighed fifteen ounces; another (Case 3) was seventy-seven years of age; while in a sixth case (No. 19), agedsixty-two, there was atheroma of the cerebral and probablyof other arteries, his lun.gs were very emphysematous, andhis kidneys weighed only eight ounces. It is assumed bySir William Gull and Dr. Sutton that kidneys weighing asmuch as fifteen ounces and as little as eight ounces werealike free from disease.

, Although it is maintained (pp. 289-90) that there is aconstant relation between the " hyalin-fibroid " change inthe vessels and hypertrophy of the heart, it is stated (p. 292)that in a few cases this change was seen in the vessels ofthe pia mater, unassociated with hypertrophy of the heart.The "hyalin-fibroid" change is supposed to lessen the

elasticity of the walls of the minute arteries, so to impedethe circulation, and to cause hypertrophy of the left ven-tricle (p. 290). Dr. Johnson maintains that in this explana-tion the elasticity of the larger arteries, which acts in aidof the heart as a propelling force, is confounded with themuscularity of the smaller arteries, which antagonises theheart. Degeneration of the muscular walls of the arterioleswould involve, not an increase, but a decrease of resistance,and therefore would not explain the cardiac hypertrophy.It is stated by Gull and Sutton (p. 295) that thickening ofthe arterial walls is always associated with atrophy of theadjacent tissues. Yet they state (p. 287) that these arteriesare thickened in the walls of the hypertrophied heart, andthey are also thickened in the large white kidney.Going on to discuss the nature of the " hyalin-fibroid"

change, Dr. Johnson maintains that it is not an ante-mortem pathological change, but a post-mortem physicalresult of the distension of the fibrous tunic of the arteriesby the mixture of glycerine and camphor water, in whichall the specimens had been mounted before they were ex-amined by the authors of this theory. He maintains thatthe appearance in question is never seen in vessels examinedimmediately after their removal from the body, or preservedin dilute spirit, or in a solution of salt of specific gravity 1030,while it is frequently, but not constantly, observed in spe-cimens mounted in glycerine. Normal arteries from thepia mater mounted in these different fluids present astriking contrast; those in dilute spirit or in salt-and-water